Newborns may get Covid-19 transmission from mothers: ICMR issues guidelines

There is currently no evidence to favour one mode of birth over another.
According to the Indian Council of Medical Research (ICMR), there is a possibility of transmission of coronavirus from a pregnant mother to a newborn baby. However, the proportion of pregnancies affected and the significance to the newborn is yet to be determined, ICMR said on Monday.

The available scientific evidence suggests that transmission of the virus can happen to a baby before the birth, while it is in the mother's womb, or during delivery from an infected pregnant mother. However, the country's top medical research body added that at present, there are no recorded cases of breast milk being tested positive for Covid-19.

Issuing guidance for the management of pregnant women during the Covid-19 pandemic, ICMR said, "There are reports of Covid-19 pneumonia in pregnancy which are milder and have a good recovery. Also, there are case reports of pre-term birth in women with Covid-19, but it is unclear whether the pre-term birth was always iatrogenic, or whether some were spontaneous."

"A registry for all women admitted with confirmed Covid-19 infection in pregnancy should be maintained. Maternal and neonatal records including outcome should be completed in detail and preserved for analysis in the future," according to the ICMR.

"With regard to vertical transmission (transmission from mother to baby antenatally or intrapartum), emerging evidence now suggests that vertical transmission is probable, although the proportion of pregnancies affected and the significance to the neonate has yet to be determined."

"It is unknown whether newborns with Covid-19 are at increased risk for severe complications. Transmission after birth via contact with infectious respiratory secretions is a concern. Facilities should consider temporarily separating (e.g. separate rooms) the mother who has confirmed Covid-19 from the baby until the mother's transmission-based precautions are discontinued."

Pregnant women with heart disease are at the highest risk (congenital or acquired). However, currently, there are no data suggesting an increased risk of miscarriage or early pregnancy loss in relation to Covid-19. 

"There is no evidence currently that the virus is teratogenic. Long term data is awaited. COVID-19 infection is currently not an indication for medical termination of pregnancy," stated the document.

ICMR pointed out that health care practitioners should immediately create an isolation facility for pregnant mothers with Covid-19 and should follow the national protocol.

There is currently no evidence to favour one mode of birth over another. Mode of birth should not be influenced by the presence of Covid-19 unless the woman's respiratory condition demands urgent delivery. When cesarean birth or other operative procedure is advised, it should be done after wearing PPE, states ICMR.

These recommendations are adapted based on guidelines from international agencies like CDC, ACOG, RCOG, FOGSI and Lancet publications. However, they are simplified and made user friendly for the Indian context. This guidance is prepared considering resources in our government health settings.

Meanwhile, West Bengal Health Ministry directed all medical college hospitals to have separate OT for such pregnant women. "The standards and facilities required for infection control in these areas should be the same as that of other adults with suspected and confirmed Covid-19 infection," the guideline stated.

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